Sunday, January 23, 2011

How Easy Obamacare Could Have Been Fixed

Truth-Out.org reprinted Chapter 5 from Thom Hartmann's excellent book Rebooting the American Dream on its site. The title of the chapter - "Medicare 'Part E'- for Everybody" - summarizes its conclusion pretty succinctly: that the real solution to America's healthcare crisis is to simply allow a buy-in to Medicare for all Americans as a healthcare public option, which is pretty much my conclusion as well. It's not only good economics, it's good politics: expanding an effective and popular program that has worked is the way to go. The best thing about opening up Medicare is it wouldn't kill private insurance, but rather improve it, by forcing them to innovatively compete with real competition rather than participate in a rigged oligopoly. What's more, if universal coverage is a real goal of health reform (which apparently it isn't under Obamacare, as it is guaranteed to still exclude millions from the healthcare system) rather than have an individual mandate (i.e. forcing people to buy insurance from corrupt insurance companies, a strategy which is both politically unpopular and of at best dubious constitutional grounds) you could merely set up a payroll tax for those without private insurance, so they are automatically included in the public option. The payroll tax plan would be politically contentious, no doubt, but no more contentious than the Obamacare debate has been and with a greater upside.

Unfortunately, Obamacare didn't expand a successful and popular program like Medicare, but rather an unsuccessful and unpopular program that is for-profit korporate health insurance. The end result is we'll still have easily the worst healthcare system in the industrialized world. Hartmann notes:

"As journalist and author T. R. Reid pointed out in his seminal 2008 documentary, Sick around the World, and in his subsequent book on the topic, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, the United States is the only industrialized nation in the world that allows for-profit corporations to offer basic, primary-care health insurance. While many countries allow for-profit players in the insurance market, they’re specialized; the insurance will get you a single room or suite in a private hospital or covers things like elective cosmetic surgery - basically health insurance add-ons for the rich. But every other nation except the United States considers health care a right instead of a privilege, so they let only nonprofit companies provide insurance for it, or the nations’ governments provide it themselves."

Oh, well, too bad those evil Republicans stopped Obama and the Democrats from giving us the health care reform they really wanted to, but couldn't. After all, there were only 59 Dems in the Senate, one short of the number needed to stop the filibuster that forced the necessary compromise. There's only one problem with this argument:

"If legislation is considered in the Senate that only adjusts the amounts of revenue coming in or going out, it can be done through a process called 'reconciliation,' which requires only a simple majority - 50 votes - to pass, with the vice president to break a tie.

For example, George W. Bush and the Republicans used reconciliation - majority rule - to push through his huge cuts in taxes on the richest Americans three different times in the first decade of this century. They were not creating a new program but simply adjusting the revenue figures. Ronald Reagan had done the same. If legislation has to do only with revenue or scale adjustments to existing programs, 50 votes in the Senate are enough.

We already have Medicare, which is a fairly comprehensive basic health insurance/health-care program that covers nearly all Americans over 65 years of age. It is, in essence, a single-payer health-care program. Obama and the Democrats could easily push to expand the Medicare program to allow Americans of all ages to participate in it, and all they’d need is a simple majority, not a supermajority."

Could the Democrats get 51 votes out of 59 Senators (or 50, assuming Biden would vote yes on the tiebreaker) on expanding Medicare with a buy in for a public option? (Or, perhaps more contentiously, if you want to go the whole nine yards, a new payroll tax to create real universal coverage?) It's hard to imagine nine Democrats doing something that would be so politically unpopular, as a public option had overwhelming support in pretty much all opinion polls. But what's telling is that all it would take is one Congressman (Senate or HOR) to get this up for a vote, and not one did. No Dennis Kucinich, not even supposed independent socialist Bernie Sanders. It appears that all the Democrats in Congress would rather protect a corrupt secret deal made by the Obama Administration to the for-profit health industry than help the average American.